This 2 year project will study emerging patterns of technology assessment and decison-making in non-profit community hospitals through replication of 1976-1980 interviews concerning medical technology adoption in 25 acute care hospitals (NCHSR R01 HS 03238888-01A1). The concern is to identify changes in the decisional processes of doctors and hospitals brought about by the many changes in the funding of health care since 1980, including the phasing out of open-ended funding, and governmental planning and regulation, in favor of the marketplace for health services (primarily through prospective payment) as a functional substitute. We will conduct personal interviews with a panel of 295 individuals who were interviewed by us in 1980 (70 in both 1976 and 1980). The panel includes 174 physicians, 27 nurse and technical department heads, 42 health care executives, and 45 hospital board members. We will also interview respondents from contextual or environmental roles. The decisional process will be compared to that which these individuals in 1976 described in terms of (1) the kinds of medical innovations which are considered and accepted or rejected by given individuals and hospitals; (2) the sources of information and the innovation-related steps of individuals, professional groups and organizations; (3) the reasons given by decision-makers for accepting or rejecting innovations (values, new organizational structures, markets, etc.); and (4) organizational mechanisms for considering and selecting among technology choices.